Pfc. Manning's sex change up to a doctor, not the Army: Editorial

Chelsea Manning, formerly Bradley, wearing a wig and lipstick in an undated photo. The Army private says she plans to live as a woman named Chelsea.AP Photo

For those who can’t stand the fact that people in prison get better health care than many on the outside, this will not go over well: the idea that a convicted lawbreaker such as Army Pfc. Bradley Manning, who now goes by Chelsea, could have the right to a fully funded sex change behind bars.

Let’s first make clear that at this point, Manning isn’t asking for that. The private has said she will pay for estrogen treatments herself, and cited no plans for surgery.

The Army has not said whether she would be permitted to undergo such therapy, even at her own expense. But it has stated it does not provide this treatment in its military prisons, including the all-male facility where Manning will start a 35-year sentence.

At first blush, that may sound reasonable: Why should taxpayers fork over what could be tens of thousands of dollars to assuage the identity crisis of a convicted whistle-blower who disclosed government secrets?

But now consider the case of Vanessa Adams, formerly Nicholas Adams. The transgender inmate was diagnosed by prison doctors with gender dysphoria when she started a 20-year sentence in a nonmilitary facility for burglary. Over the next few years, Adams made at least 19 written requests asking for the hormone treatment that is supported by all the major medical associations, and was refused — simply because it was prison policy to freeze treatment for gender dysphoria at the level provided before entering custody.

As a result, Adams attempted suicide multiple times. She then tried — and ultimately managed — to castrate herself with a razor.

Now this is obviously more serious than an inmate who likes to play dress-up. Severe gender dysphoria can cause real harm, and cannot be treated with antidepressants or counseling. If a prison doctor decides estrogen treatments or even surgery is medically necessary, why should that be refused simply because the higher-ups are skeptical?

What if officials arbitrarily decided that other drugs or surgeries were not worthwhile? The courts would say it violates the constitutional rights of prisoners.

Adams’ legal action led the federal Bureau of Prisons to change its policy for civilian lockups in 2010, allowing prison doctors to prescribe hormone therapy and leaving open the option for surgery. Military prisons should follow suit.

As a society, we provide prisoners with necessary health care based on a doctor’s assessment, not society’s level of comfort or bias.